Bill Text: NJ S3226 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires insurance coverage of diapers when medically necessary.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-05-13 - Introduced in the Senate, Referred to Senate Commerce Committee [S3226 Detail]
Download: New_Jersey-2024-S3226-Introduced.html
Sponsored by:
Senator ANGELA V. MCKNIGHT
District 31 (Hudson)
SYNOPSIS
Requires insurance coverage of diapers when medically necessary.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance coverage of diapers and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et al.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
b. This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
10. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person for medical expenses incurred in the purchase of diapers, as determined medically necessary by the covered person's pediatrician or other medical doctor. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
11. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill requires health benefits coverage for medical expenses incurred in the purchase of diapers that are deemed medically necessary. Whether diapers are a medical necessity shall be determined by the covered person's pediatrician or other medical doctor.
Some persons suffer from genetic or other conditions that require the use of diapers beyond early childhood. Under this bill, insurers will be required to provide coverage for diapers for persons for whom the use of diapers is a medical necessity.
